Understanding competence assessment culture: A qualitative study

Competency-based medical education (CBME) is a global paradigm designed to align training with the needs of the healthcare system. However, its implementation relies on a shared understanding of key concepts, especially competence and its assessment, which may be interpreted differently across settings. This study explores how faculty members understand competence assessment and examines its implications for CBME implementation.

This qualitative, exploratory study was conducted at a public medical school in Brazil. Twenty self-selected faculty members participated in semi-structured, online interviews. Data were analyzed using a deductive framework method informed by four theoretical models from the CBME literature, which structured the analytic dimensions guiding coding and interpretation.

Most participants articulated an analytic mental model of competence, describing it as composed of discrete components-knowledge, skills, and attitudes-assessed independently. No participant expressed a synthetic approach centered on real-world professional tasks. Assessment was predominantly positioned as certification of learning and described as enacted through multiple, non-integrated methods. Outcomes were primarily framed as serving internal educational stakeholders, with limited reference to patients or the healthcare system.

The findings highlight how locally situated cultural understandings shape competence assessment within a formally structured CBME context. The gap between assessment practices and real-world readiness raises concerns regarding the legitimacy of certification, especially in settings lacking a structured educational continuum. Advancing CBME requires interpretive engagement and contextual responsiveness. Exploring how faculty members understand competence assessment offers a key entry point for examining culture and encouraging actions that support CBME in fulfilling its social mandate and reaffirming medical education as a public good.